Needle Tracheostomy: A Laboratory Study

Abstract

Percutaneous needle tracheostomy and transtracheal ventilation continues to be advocated for the management of upper airway obstruction. Recent studies recommend the use of artificial ventilation. However, as apparatus for this is not always available and because there remains some doubt regarding conditions for successful use of needle tracheostomy during spontaneous respiration, we undertook such a study in dogs. Pressure-flow characteristics of short hollow needles 18–10 SWG were first determined. The smallest of these (14 SWG Bardic Intracath) that would deliver flow sufficient (by calculation) to meet the respiratory requirement of 10–13 kg laboratory dogs was selected for further study. Respiration was possible by spontaneous or artificial methods in the presence of complete tracheal occlusion. Little or no deterioration was noted in an hour of such breathing. Artificial ventilation by machine and by hand could considerably lower PaCO2. We conclude that the technique is possible provided appropriate needles are selected and care is given to their method of use.

Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children?

“…This technique has been shown to maintain adequate oxygenation in spontaneously breathing dogs (∼20 kg) for 45 min or longer providing adequate time to establish a more definitive airway (25,31). Similarly in paralyzed dogs by disabling the pop off‐valve, assisted ventilation maintained adequate oxygenation but with both there was some degree of hypercarbia that was well tolerated (Figure 2a,b) (25).…”

“…Many inventive means for accessing the trachea have been described including the spike from an intravenous tubing set (30). Early descriptions of this technique involved the use of a large bore needle (31–34); this approach later substituted an intravenous catheter rather than a needle (11,24,25). In 1992, the American Heart Association changed their recommendations for emergency airway management in children to a percutaneous needle cricothyrotomy in place of a surgical cricothyrotomy because it was felt that there is less risk of injury to vital structures, particularly in the hands of nonsurgically trained practitioners (35).…”

Pediatric Needle Cricothyrotomy: A Case for Simulation in Prehospital Medicine

“…This airway intervention is only a temporary solution and should not be used for longer than 45 minutes. 6,7 If ground transportation time is longer than this time period, air transportation may be necessary.…”